Lin Jen-Der, Lin Kun-Ju, Chao Tzu-Chieh, Hseuh Chuen, Tsang Ngan-Ming
Department of Internal Medicine, Chang Gung University, Taiwan, ROC.
Radiother Oncol. 2008 Oct;89(1):97-104. doi: 10.1016/j.radonc.2008.05.011. Epub 2008 Jun 3.
This retrospective study analyzed the role of total or near-total thyroidectomy and adjuvant radioactive iodide ((131)I) therapy in papillary thyroid carcinoma patients with disease more advanced than T1N0M0.
The study analyzed 1055 consecutive papillary thyroid cancer patients, 825 women and 230 men, who underwent near-total or total thyroidectomy, thyroid remnant ablation with (131)I, and follow-up at Chang Gung Medical Center in Linkou, Taiwan. Patients with T1N0M0 stage tumors were excluded. Patients were categorized into four groups according to treatment outcome. Group A was disease-free patients with negative results of (131)I whole body scan, undetected serum thyroglobulin (Tg) and Tg antibody, and no recurrence. Group B patients had no clinical evidence of persistent or recurrent thyroid cancer but were not in disease-free status. Group C were patients with cancer tissue persisting after surgery. Group D were patients suffering cancer recurrence after surgery and (131)I ablation.
After a mean follow-up period of 10.1+/-5.4 years (median: 9.5 years), 46 (4.36%) patients died of thyroid cancer. Nine Group A cases with persistent or recurrent cancer were treated until achieving disease-free status. Group C patients received the highest (131)I dose but had a 25.7% mortality rate. In Group D, the mean duration from first thyroidectomy to recurrence was 5.1+/-0.4 years and ranged from 0.8 to 18.7 years. Four of 56 (7.1%) patients with recurrent local neck cancer died of thyroid cancer and 12 (21.4%) died of thyroid cancer with distant metastases.
Radioactive iodide therapy effectively controlled papillary thyroid carcinoma after neck surgery in 23.9% of patients. After surgery and (131)I treatments, most patients with persistent or recurrent local-regional neck cancer were free of relapse; the cancer mortality rate was 19.0%.
本回顾性研究分析了全甲状腺切除术或近全甲状腺切除术及辅助放射性碘（¹³¹I）治疗在疾病分期超过T1N0M0的甲状腺乳头状癌患者中的作用。
该研究分析了1055例连续的甲状腺乳头状癌患者，其中825例女性，230例男性，这些患者在台湾林口长庚医学中心接受了近全甲状腺切除术或全甲状腺切除术、¹³¹I甲状腺残余消融及随访。T1N0M0期肿瘤患者被排除。根据治疗结果将患者分为四组。A组为¹³¹I全身扫描结果阴性、血清甲状腺球蛋白（Tg）和Tg抗体未检测到且无复发的无病患者。B组患者无持续性或复发性甲状腺癌的临床证据，但未处于无病状态。C组为术后仍有癌组织残留的患者。D组为术后及¹³¹I消融后出现癌症复发的患者。
平均随访10.1±5.4年（中位数：9.5年）后，46例（4.36%）患者死于甲状腺癌。9例A组持续性或复发性癌症患者接受治疗直至达到无病状态。C组患者接受的¹³¹I剂量最高，但死亡率为25.7%。D组中，从首次甲状腺切除到复发的平均时间为5.1±0.4年，范围为0.8至18.7年。56例（7.1%）局部颈部复发癌患者中有4例死于甲状腺癌，12例（21.4%）死于伴有远处转移的甲状腺癌。
放射性碘治疗在23.9%的患者颈部手术后有效控制了甲状腺乳头状癌。手术及¹³¹I治疗后，大多数持续性或复发性局部区域颈部癌患者无复发；癌症死亡率为19.0%。
